Twin epidemics of poverty and diabetes disparities: Understanding barriers to health in a low-income Latino and immigrant neighborhood

Abstract In the United States, low-income immigrant groups experience greater health disparities and worse health-related outcomes than whites, including but not limited to higher rates of type 2 diabetes (hereafter diabetes), a disease whose prevention and adequate management are, to a great extent, contingent on access to healthy nutrition. This pilot exploratory study examines barriers to health among low-income Latino immigrants in Northern California. We concentrate on barriers to healthy food environments and on the sources of diabetes disparities. Methods are mixed, and data include interviews to social service providers at a local non-profit agency, focus groups and surveys of clients of the agency, exclusively of those who are monolingual Latino immigrants, and estimation of the thrifty food market basket in local grocery stores. We find that while participants identify diabetes as the greatest health problem in the community, access to healthy foods is importantly restricted, geographically, culturally, and economically. While 100% of households rely on informal food assistance (e.g. food pantries, soup kitchens) and meet the income requirements to qualify for food stamps, less than 50% receive them, due to barriers posed by immigration status. Even those eligible for food stamps experience multiple poverty-related barriers to healthy food and other health-relevant environments. Our analysis underscores the deep socioeconomic dimension of, and physiological relationship between, poverty, diabetes disparities, and health disparities more generally. We propose that interventions to reduce diabetes and likely other health disparities must incorporate a social justice perspective that guarantees a right to adequate quantities and quality of food and to safe environments, and concomitantly, a right to health.